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Breaking point: How the coronavirus pandemic will push fragile states towards catastrophe in 2021

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Executive summary

As the UK deals with a new strain of Covid-19 and attention here is rightly focused on the domestic disaster, we must not forget the world’s most fragile states where the pandemic is magnifying existing health and socio-economic challenges with devastating effects.

These places, beset by years of conflict, violence and natural disasters such as drought and flooding, have left millions of displaced and other vulnerable people with poor access to adequate healthcare, water, food and ways to earn an income.

The Disasters Emergency Committee (DEC), which brings together 14 leading UK aid charities to raise funds for countries without the capacity to respond in the face of a large-scale humanitarian disaster, launched its Coronavirus Appeal in July 2020 when it became clear that Covid-19 was going to be devastating for the world’s poorest communities.

This report examines the impact of Covid-19 so far and what the year ahead holds for the world’s most fragile states – Yemen and Syria in the Middle East; Somalia, South Sudan and the Democratic Republic of Congo (DRC) in Africa; Afghanistan in Asia – and the Rohingya refugee camps in Bangladesh.

Evidence comes from DEC-commissioned independent Response Reviews in these seven places, interviews with country directors and senior staff from the 14 DEC charities as well as UN representatives in these fragile states, and a survey of senior staff at DEC charities on the ground and their local partners.

The central findings of the survey are alarming. Almost all (98%) agreed that the pandemic had worsened the humanitarian crisis in their respective countries, with three quarters (73%) saying it is the worst it has been in the last 10 years.

Covid-19 cases and deaths are substantially underreported due to lack of data, stigma and fear.

It is easy to underestimate levels of coronavirus in these fragile states. Covid-19 cases and deaths are substantially underreported due to lack of data, stigma and fear to the extent that the true picture is not known. Nonetheless, already fragile health services are being disrupted and overwhelmed, despite the fact that many people are too scared to go to health centres or hospitals for fear of catching the disease, or stigma of being thought infected. Others are reluctant to attend in case they are caught up in violence on the way.

The economic impact of the virus is, however, undeniable. The pandemic has led to worsening inflation, higher prices, less trade and therefore fewer jobs and ways of earning an income, particularly for those in informal, daily paid work or who rely on remittances from family abroad.

Many people in these countries have no resources to fall back on and no economic safety net provided by the state. Lower income means less food. In the DEC member survey, 96% said the economic impact of Covid-19 had affected people’s ability to buy food and other essentials.

As a result, increasing numbers of people are going hungry, reducing the number of meals they eat a day and, in the worst-hit places, the spectre of famine looms. Parts of South Sudan and Yemen are on the brink of such a catastrophe, while Afghanistan and DRC are at risk. In the DEC member survey, 83% agreed or strongly agreed that, without increased funding, thousands are likely to die from hunger in 2021.

Meanwhile, people in many fragile states have to deal with continuing conflict which often seems to them an even bigger problem than coronavirus, and something more likely to kill them. Together, though, conflict and Covid-19 are a fatal combination. Conflict causes huge displacement of people. For example, more than a million were displaced in northwest Syria alone in the three months before the pandemic hit. The impact of the virus on displaced people, commonly living in makeshift tents and shelters, has been particularly severe because it’s more difficult for them to find jobs and access healthcare.

Worryingly, aid funding is reducing just at the time that humanitarian needs are rising. The UN predicted in December that a record 235 million people globally will need humanitarian assistance and protection in 2021, a near 40% increase on 2020. This is almost entirely due to Covid-19, it said, but humanitarian aid budgets face dire shortfalls as a result. Country directors of DEC members fear having to re-prioritise which life-saving programmes should be funded and which of the most vulnerable people should receive humanitarian relief.

The vaccine rollout offers hope, with the Covax facility ensuring that even the poorest countries will receive immunisations for health workers and the most vulnerable people, but it is not a panacea. Delivery will be challenging in areas with little infrastructure and where there is conflict, and will unlikely make a marked difference this year to the immense challenges faced by the world's most fragile states.

In the meantime, DEC charities will continue to help provide vital support such as health services to care for people who become ill from the virus, routine vaccination programmes, and mother and baby clinics. They will ensure water and sanitation systems are maintained so that disease outbreaks can be prevented. Displaced people reliant on food aid will be supported too and other vulnerable people will receive vouchers or cash grants to buy food.

In the first three months of the first phase (July 2020 to January 2021) of the DEC-funded humanitarian response to the pandemic, donations to the DEC appeal were primarily spent on health projects (26%), including isolation and treatment centres, supporting fragile health systems and providing PPE to frontline medics. There was also a focus on water, sanitation and hygiene activities (25%), such as providing clean water, handwashing stations and hygiene kits. Other priorities included supporting livelihoods (18%) and providing food (8%).

Funding is making a significant difference: in the DEC member survey, 88% agreed or strongly agreed that humanitarian action had helped prevent the spread of Covid-19 in their country. But in the coming year, as funding reduces and needs increase, there will be hard choices to be made about which basic human needs should take priority.

In the next phase of the DEC-funded response, in the face of unprecedented levels of need and the threat of famine, a top priority will be to reduce hunger levels with food aid such as supplies of beans and rice, vouchers to buy food and cash grants which also help stimulate the local economy.

A continued investment in Covid-19 prevention, suppression and treatment measures – such as equipping isolation or quarantine facilities, training frontline health workers, and delivering public health messages – will also provide a valuable legacy, helping tackle future waves of Covid-19 as well as outbreaks of other diseases.

The generosity that the UK public, government, companies and institutions have shown through their donations to the DEC Coronavirus Appeal has been truly appreciated, given the scale of the disaster being faced at home. This report shows that unprecedented levels of need lie ahead but that funds to provide humanitarian assistance are and will continue to make a direct and practical difference to people in the world’s most perilous places.

About the DEC

When large-scale disasters hit countries without the capacity to respond, the DEC brings together 14 leading UK aid charities to raise funds quickly and efficiently. In these times of crisis, people in life-and-death situations need our help and our mission is to save, protect and rebuild lives through effective humanitarian response.

The DEC’s 14 member charities are: Action Against Hunger, ActionAid UK, Age International, British Red Cross, CAFOD, CARE International UK, Christian Aid, Concern Worldwide UK, Islamic Relief Worldwide, Oxfam GB, Plan International UK, Save the Children UK, Tearfund and World Vision UK.

About the DEC’s Coronavirus Appeal

In July 2020, the Disasters Emergency Committee (DEC) launched its Coronavirus Appeal to help people living in the world’s most fragile states, already affected by conflict and extreme poverty, fight the new threat brought by the pandemic.

To date, the collective fundraising campaign has raised more than £36 million from the UK public and other donors. The funds raised are being used to:

  • help give vulnerable displaced families the means to protect themselves from the virus with water, soap, handwashing stations and information;
  • support frontline medical and aid workers with protective equipment, medical supplies and training so they can care for the vulnerable and sick;
  • ensure that the Covid-19 crisis doesn’t mean people go hungry and children become malnourished.

Appeal funds were allocated to the DEC’s 14 member charities which were already working in the prioritised states:

  • Yemen and Syria in the Middle East;
  • Somalia, South Sudan and the Democratic Republic of Congo in Africa; and
  • Afghanistan in Asia, as well as Rohingya refugees in Bangladesh.

There are 24 million internally displaced people in total in these fragile states, and an additional 850,000 Rohingya people living in the world’s biggest refugee camp in Bangladesh.

Appeal funds are being used to adapt on-going programmes to fight transmission of the virus, to develop new programmes to respond to the health impact of Covid-19 as well as to help communities cope with the socio-economic impact of lockdowns and other preventative measures. A total of £36 million has been raised since the appeal launched on 14 July 2020, including £10 million from the UK Government’s Aid Match scheme. This report provides examples of how, during the first three months (July - October 2020) of the DEC’s planned 18-month pandemic response, our members used funds donated directly to the DEC appeal.

How this report was compiled

The research for this report was conducted between October 2020 and February 2021 using a range of sources including evidence from the seven Real-Time Response Reviews of each appeal country that the DEC commissioned from independent consultants Groupe URD. The purpose of these reviews is to generate real-time learning about how the first six months of the DEC-funded humanitarian response has progressed, better understand how the pandemic has affected the most vulnerable communities and make recommendations for how aid delivery can be improved in the next phase of the response starting in February 2021.

The Real-Time Response Reviews included interviews with field staff, local partners, government entities, local authorities and international aid agencies; discussions with affected populations through individual interviews with local key informants (eg village chiefs, local health responders) and focus group meetings; and direct observation of programmes activities.

Additional information was gathered through a survey of 48 country directors and senior humanitarian staff from the DEC’s 14 member charities operating in the seven appeal locations, as well as 21 interviews with senior representatives from DEC members working in country in the seven appeal locations and six interviews with senior representatives of the United Nations Office for the Coordination of Humanitarian Affairs (UN OCHA) and World Health Organisation representatives in Afghanistan, Somalia, South Sudan, Syria and Yemen.

*Names changed to protect identities.

Read the full report here.